From the Maternity Ward to the Autopsy Room

The Longform guide to hospitals.

A sign is seen in front of Memorial Hospital in September 2005 in New Orleans, where 45 patients were found dead after Hurricane Katrina evacuation efforts were thwarted and temperatures inside the hospital reached 106 degrees.

Photo by Justin Sullivan/Getty Images

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After Katrina’s floodwaters knocked out power and marooned New Orleans’ Memorial Medical Center, evacuating all the hospital’s patients seemed impossible. Following the controversial choices of the medical staff who tried to “do the greatest good” with no triage procedures in place.

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“Gremillion’s supervisor and friend, a LifeCare nursing director, Gina Isbell, told me she walked into the room around 11 a.m. and saw Gremillion crying and shaking his head. He brushed past her into the hallway, and Isbell followed, grabbing his arm and guiding him to an empty room. ‘I can’t do this,’ he kept saying.

“‘Do what?’ Isbell asked. When Gremillion wouldn’t answer, Isbell tried to comfort him. ‘It’s going to be O.K.,’ she said. ‘Everything’s going to be all right.’

“Isbell searched for Robichaux, her boss. ‘What is going on?’ she asked, frantic. ‘Are they going to do something to our patients?’

“‘Yes, they are,’ Isbell remembers Robichaux, in tears, saying. ‘Our patients aren’t going to be evacuated. They aren’t going to leave.’ As the LifeCare administrators cleared the floor of all but a few senior staff members, Robichaux sent Isbell to the back staircase to make sure nobody re-entered. It was quiet there, and Isbell sat alone, drained and upset. Isbell said she thought about her patients, remembering with guilt a promise she made to the daughter of one of her favorites, Alice Hutzler, a 90-year-old woman who came to LifeCare for treatment of bedsores and pneumonia. Isbell fondly called her Miss Alice and had told Hutzler’s daughter that she would take good care of her mother. Now Isbell prayed that help would come before Hutzler and her other patients died.

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“According to statements made to investigators by Steven Harris, the LifeCare pharmacist, Pou brought numerous vials of morphine to the seventh floor.”

On David Arndt, a prominent Boston surgeon famous for leaving a patient in the operating room while he went to cash a paycheck.

“It was as though his friends were seeing a David Arndt, version 2.0—a better-looking package but one that lacked the charm of the original release. ‘He once told me, “I'm like Dorian Gray. I just get better looking as I get older,” ‘ Colfax recalls. ‘It takes a certain personality to just state that. And I thought it was an interesting literary reference, considering what the novel was about.’

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“The central character in Oscar Wilde's The Picture of Dorian Gray manages to defy age and remain youthfully handsome. But he loses his inner compass. In the end, Dorian Gray pays dearly for his vanity.

“If David Arndt sounds a little too intense, a little too arrogant, ask yourself this: Aren't those exactly the qualities you want in a surgeon? Because this is what his arrogance looked like for most of his time in the operating room: An intolerance for error. An eagerness to take on the toughest cases. A fearlessness about confronting anyone—be it an orderly or a chief of surgery—who he thought was underperforming. Even as an intern, he would routinely challenge the attending physicians. ‘Interns are supposed to always back down, but not David,’ recalls Alexandra Page. ‘The rest of us were like, “You go, man!”’”

Inside Landstuhl, the single German hospital where every American soldier wounded in Iraq or Afghanistan is treated.

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“‘You know whose birthday it is, too?’ W. says. “That guy who got his nuts blown off. He’s 21 years old, sitting in the intensive-care unit. His penis was what they call degloved. The whole top layer of skin was blown off. Happy birthday, right?’ Tears well up in her eyes, and she tries to hide them with the back of her ﬁst. She doesn’t pretend to hide them; she genuinely seems pissed that she’s crying. W. doesn’t want to be laying claim to the pain of these people. I remember talking to a vascular surgeon who came here unpaid, and while he found the work totally satisfying, he still felt somehow that the war was a total mystery to him. Sigmond’s friend (he doesn’t want his name printed) says, ‘There’s a disconnect between soldiers and the people who are taking care of them. The soldier will look to see if you’ve got a combat patch. They see I have one, so sometimes that helps. But they also know I’m not there. So we’re all kind of outsiders.’

“The truth is that the men who come to the hospital on those buses, they mostly seem so far away that you can barely see them. You can walk into the wards and turn on your tape recorder and talk to them for an hour or so while they ﬁght to pay attention to you instead of whatever signiﬁcant pain they are in, you can watch them in the operating room while they lose consciousness, you see what they look like and try to understand the events that brought them here and imagine what all that must be like. But what happened to them happened to them, and though you are in the same physical space, you may as well be on the phone to Mars. W. and her friend, they are saying that the folks here at the Irish pub know what it’s like to work here, to lay hands on the catastrophically injured. But even they do not really have access to them.”

After their daughter was born with a deadly bone marrow disease, Lisa and Jack Nash became the first parents in history to genetically engineer a child in order to create a donor for her. The story of saving 5-year-old Molly and the public debate that followed.

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“At 1:20 p.m. on Tuesday, Sept. 26, 2000, a nurse walked into Molly's room carrying a bag of her new brother's blood. A rabbi joined the family to bless Molly's ‘new life.’ While the slow, syrupy-thick drip began, Molly's family sang happy birthday—what everyone hoped would be the beginning of the rest of her life—and snapped pictures. Molly's baby brother, not even a month old, sat on her lap.

“Jack could smell the blood. It smelled like creamed corn. Looking on, the mother in Lisa thought, ‘You expect thunder and lightning and miracles.’ But the nurse in her saw it was only a bag attached to a central line. The Nashes watched the clock. The transfusion—so many years in the making—lasted just 25 minutes. The family ate forkfuls of cake emblazoned with ‘Happy Transplant Day.’ Molly looked no different. No thunder. No lightning.

“The Nashes prayed that the blood stem cells would find their way home to the empty bone marrow cavities. If all went well, the cells would set up shop and begin producing normal cells within weeks. Until then, blood transfusions, potent antibiotics, and a healthy dose of luck would keep Molly from falling ill. Wagner would monitor her blood counts with daily labs. And for days, that was how it went.”

After 19 years, a doctor confesses about his time harvesting organs from political prisoners in China.

“A few months later, three death row prisoners were being transported from detention to execution. Nijat had become friendly with one in particular, a very young man. As Nijat walked alongside, the young man turned to Nijat with eyes like saucers: ‘Why did you inject me?’

“Nijat hadn’t injected him; the medical director had. But the director and some legal officials were watching the exchange, so Nijat lied smoothly: ‘It’s so you won’t feel much pain when they shoot you.’

“The young man smiled faintly, and Nijat, sensing that he would never quite forget that look, waited until the execution was over to ask the medical director: ‘Why did you inject him?’

“‘Nijat, if you can transfer to some other section, then go as soon as possible.’

“‘What do you mean? Doctor, exactly what kind of medicine did you inject him with?’

“‘Nijat, do you have any beliefs?’

“‘Yes. Do you?’

“‘It was an anticoagulant, Nijat. And maybe we are all going to hell.’

“Before my first shift, I worked my way through the bags with a paramedic named Suzanne Noël. It was impossible to cover everything that might happen on a given shift—broken bones, strokes, childbirth, heart failure, brain injury, gunshot wounds, stab wounds, toxic shock—or where the drama might take place: in a bedroom, a bar, or a car upside down in a ditch. It's a job that requires a free kind of spirit, and like most paramedics I met, Suzanne was bright-eyed and quick to smile. ‘Seeing what we see, we know how lucky we are to be alive,’ she said.

“It was one of the great lessons of the truck. I expected to find a bunch of burnouts dragging through the graveyard shift, broken men and women who dipped into the blue bag so they might find sleep. But paramedics are a surprisingly sunny bunch. They understand that it's all so much randomness anyway, a cosmic confluence of vectors. One night, four kids got into a car and raced down the slushy streets until the driver lost control. The car spun like a roulette wheel before it was finally stopped by a streetlight. One kid, unlucky enough to have chosen the seat that ended up with the streetlight in it, suffered massive head injuries. The other three walked away. They knew the out-of-body feeling that follows the cheating of death, the feeling that every day between that day and their last will be a gift that so easily could have gone unopened. Paramedics know that feeling better than anyone, because they walk out of nightmares unscathed again and again. They know what a genuinely bad day really looks like, and they know that day will come for them, too, but today is not that day, and that knowledge alone was reason enough for Suzanne to smile.”

On his deathbed, a longtime Harper’s contributor considers the state of ethics in America.

“Without ethics, politics has no limits. America broke the rules of living systems, and lost its balance. All the oxygen flowed to a smaller and smaller section of the body politic. The history is brief and unquestionable: close to toppling, the society momentarily pulled itself upright, and then became even less ethical, less balanced, more endangered than ever as a lawless financial system came back from death, and like a foolish patient after a heart bypass operation, continued in its old ways. With no ethical component to national politics, President Obama could deliver his 2011 State of the Union speech without ever mentioning the word ‘poverty,’ although one in every five American children lived in poverty. Without a commitment to Hutcheson’s idea of the greatest good, which is at the core of the original American philosophy in Jefferson’s drafting of the Declaration of Independence, this may no longer be the brilliant experiment. If happiness is for the few and it produces unemployment approaching that of the Great Depression, then the shadow of evening is here.

“Death is the moment when evening passes into night. I know. There is no surprise, and it often comes after a long sickness that is worse than death. When I died, I died of many things: the failing systems; the weakening of age; the exhaustion of the long war against dying. Finally, I succumbed to the lack of ethics in a California hospital, killed by filth and neglect.”

On the decline of the American autopsy and the fallibility of modern medicine.

“I felt her abdomen. It could be anything, I thought: food poisoning, a virus, appendicitis, a urinary-tract infection, an ovarian cyst, a pregnancy. Her abdomen was soft, without distension, and there was an area of particular tenderness in the lower right quadrant. When I pressed there, I felt her muscles harden reflexively beneath my fingers. On the pelvic exam, her ovaries felt normal. I ordered some lab tests. Her white-blood-cell count came back elevated. Her urinalysis was normal. A pregnancy test was negative. I ordered an abdominal CT scan.

“I am sure I can figure out what's wrong with her, but, if you think about it, that's a curious faith. I have never seen this woman before in my life, and yet I presume that she is like the others I've examined. Is it true? None of my other patients, admittedly, were forty-nine-year-old women who had had hepatitis and a drug habit, had recently been to the zoo and eaten a Fenway frank, and had come in with two days of mild lower-right-quadrant pain. Yet I still believe. Every day, we take people to surgery and open their abdomens, and, broadly speaking, we know what we will find: not eels or tiny chattering machines or a pool of blue liquid but coils of bowel, a liver to one side, a stomach to the other, a bladder down below. There are, of course, differences—an adhesion in one patient, an infection in another—but we have catalogued and sorted them by the thousands, making a statistical profile of mankind.”